Wax Removal

Name the three structures of the outer ear.

The pinna, the external auditory canal, the tympanic membrane.

Properties of ear wax

Being oily: it prevents the skin and the tympanic membrane from drying out.

Being sticky: it acts as a trap for relatively large objects.

Being acidic (having a low ph of about 6.1) prevent infection and inhibits the growth of fungi

Label the tympanic membrane.

Left tympanic membrane? how did you know this - as light index reflected.

Label the pinna

Name the functions of the external auditory meatus.

enhancement of sound and protection against foreign bodies.

Where do we get the referral criteria from?

The BAA and the BSHAA guidance.

A patient has had a sudden loss of hearing, when is this referrable?

Urgently referrable to Accident and Emergency.

What if the patient has earache and persistent pain (otalgia)

If intrusive or ongoing for a week or more in the last 90 days - urgent referral to the GP

History of discharge (otorrhoea) otoscopy can be performed.

This is referrable to the GP (urgent) if within the last 90 days and has not been investigated.

When is rapid loss / deterioration of hearing referrable (urgent referral)? otoscopy can be performed

deterioration of hearing (unilaterally/bilaterally) in the last 90 days to the GP as an urgent referral

What is hyperacusis and when would this be referred? otoscopy can be performed.

An intolerance to everyday sounds so referred to GP/ENT if worsened or not investigated.

When is tinnitus referrable? otoscopy can be performed.

is troublesome, unilateral, pulsatile or has significantly changed in nature.

Who is the referrable to (tinnitus)?

GP/ENT in accordance with your store - otoscopy can be performed.

What is vertigo and when is this referred? (otoscopy can be performed)

A hallucination of movement (floating sensation). Referred to GP/ENT in accordance with store.

What is abnormal auditory perception and when is this referred? otoscopy can be completed.

abnormal difficulty in hearing when in noisy places or failure to perceive sound properly. GP/ENT if not investigated or worsened.